From the Research
The management of IgA vasculitis primarily involves supportive care for mild cases and more aggressive treatment for severe manifestations, with glucocorticoids being the first-line therapy for severe cases, especially in adults with significant renal involvement, as recommended by the most recent study 1. The approach to managing IgA vasculitis can be broken down into several key components:
- For mild disease with primarily skin involvement and mild joint pain, supportive measures include:
- Adequate hydration
- Rest
- Pain control with acetaminophen or non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen (10-15 mg/kg/dose every 6-8 hours)
- Patients with significant abdominal pain may require short courses of oral prednisone (1-2 mg/kg/day for 1-2 weeks, followed by a taper) 2.
- For severe cases with significant renal involvement (nephrotic-range proteinuria or declining renal function), more aggressive immunosuppression is warranted, including:
- High-dose corticosteroids (methylprednisolone 30 mg/kg/day for 3 days, followed by oral prednisone)
- Sometimes cyclophosphamide, azathioprine, or mycophenolate mofetil
- Angiotensin-converting enzyme inhibitors or angiotensin receptor blockers are often added for patients with proteinuria to reduce protein excretion and protect kidney function 1, 3. Regular monitoring of blood pressure, urinalysis, and kidney function is essential during the acute phase and for at least 6 months after diagnosis, as renal complications can develop later 4, 5. The rationale for immunosuppressive therapy is to reduce the immune complex-mediated inflammation that characterizes IgA vasculitis, while supportive care helps manage symptoms until the typically self-limited disease resolves.